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1.
Milagrosa Santana Hernández Ione Ahedey Aguiar-Santana Fernando Artiles Campelo Elena Colino Gil 《Enfermedades infecciosas y microbiología clínica》2018,36(10):607-611
Objectives
To calculate the incidence of invasive pneumococcal disease (IPD) in the paediatric population of Gran Canaria (Spain), its clinical and epidemiological characteristics, serotype distribution, antibiotic resistance, and variations in these variables before and after the introduction of the PCV13 vaccine.Methods
Prospective hospital-based study including all patients (190) aged 0–14 years admitted with confirmed IPD between January 2001–May 2010 (152 cases) and June 2010–December 2016 (38 cases). Patients were divided into 3 age groups (<2 years; 2–5 years; and >5 years). Clinical symptoms were mutually-exclusively classified as meningitis, bacteraemic pneumonia, pleural effusion (PE), empyema or bacteraemia without a focus.Results
Most cases occurred in boys (59.47%), during autumn-winter (65.79%), in children aged <2 years (55.79%) and with mean age increasing from the pre-PCV13 to the post-PCV13 period (2.5 vs 3.1 years). Incidence between periods reduced by 66.4% (p < 0.001): from 13.1/100,000 to 4.4/100,000. PEs (3.9% vs 18.4%, p < 0.005) and empyemas (1.5% vs 16.7%, p = NS) increased in the post-PCV13 period whereas all other symptoms decreased, although this was not statistically significant. Vaccine serotypes (77% vs 40.6%, p = 0.000), particularly serotypes 19A (23.9% vs 12.5%) and 14 (14.2% vs 9.4%), as well as erythromycin resistance (57.2% vs 7.9%, p = 0.000) decreased in the post-PCV13 period.Conclusion
IPD incidence, vaccine serotypes and erythromycin resistance decreased in the post-PCV13 period whereas PEs increased. 相似文献2.
Pello Latasa Zamalloa Juan Carlos Sanz Moreno María Ordobás Gavín María Dolores Barranco Ordoñez Esther Insúa Marisquerena Ángel Gil de Miguel Abelardo Claudio Fernández Chávez Luis García-Comas 《Enfermedades infecciosas y microbiología clínica》2018,36(10):612-620
Introduction
Streptococcus pneumoniae is an important cause of morbidity. Vaccination is the most effective measure to prevent it. The aim of this study is to analyse the evolution of invasive pneumococcal disease (IPD).Material and methods
Observational study of IPD cases notified to the Epidemiological Surveillance Network of the Autonomous Community of Madrid between 2008 and 2015. The IPD case was defined as the disease caused by Streptococcus pneumoniae, with isolation and DNA or antigen detection, in samples from normally sterile sites. The isolated strains were sent to the Regional Public Health Laboratory for identification of the serotype. Serotypes were classified according to their inclusion in the 7-valent conjugate vaccine (PCV7), in the 13-valent vaccine, but not in the 7-valent vaccine (PCV13-additional) and not included in the 13-valent vaccine (non-PCV). The Incidence Rate Ratios (IRRs) were calculated comparing the 2011-2012 and 2013-2015 periods with the 2008-2010 period.Results
4,307 cases were reported. 86.6% were serotyped. The IRR of IPD was 0.67 and 0.67 for all serotypes; 0.43 and 0.45 for PCV7 serotypes; 0.46 and 0.25 for PCV13-additional serotypes, and 1.01 and 1.32 for non-PCV13 serotypes in the 2011-2012 and 2013-2015 periods. The incidence of serotypes 8, 9 N, 10A, 23B, 24F and serogroup 33 increased significantly in the 2013-2015 period. Serotypes 15B and 24F accounted for 24% of non-PCV13 cases in children under 5 years, serotypes 8 and 9 N for 51% in the population aged 5 to 59 years and serotypes 8 and 22F for 25% in the population aged over 59 years.Conclusions
The incidence of serotypes not included in conjugate vaccines has increased, especially in children under 5 years, but the total incidence of IPD has decreased. It is important to continue with the epidemiological and microbiological surveillance programmes to assess the effect of vaccination on the incidence of IPD. 相似文献3.
Luis Pérez de Llano Borja G. Cosío Marc Miravitlles Vicente Plaza 《Archivos de bronconeumología》2018,54(4):198-204
Objectives
We aimed to characterize the clinical, functional and inflammatory features of patients diagnosed diagnosed with ACO according to a new algorithm and to compare them with those of other chronic obstructive airway disease (COAD) categories (asthma and COPD).Methods
ACO was diagnosed in a cohort of COAD patients in those patients with COPD who were either diagnosed with current asthma or showed significant blood eosinophilia (≥300 cells/μl) and/or a very positive bronchodilator response (>400 ml and >15% in FEV1).Results
Eighty-seven (29.8%) out of 292 patients fulfilled the ACO diagnostic criteria (12.8% asthmatics who smoked <20 pack-years, 100% of asthmatics who smoked ≥20 pack-years, 47.7% of COPD with >200 eosinophils/μl in blood and none with non-eosinophilic COPD). ACO, asthma and COPD patients showed no differences in symptoms or exacerbation rate. Mean pre-bronchodilator FEV1 in ACO and asthma were similar (1741 vs 1771 ml), higher than in COPD (1431 ml, p < 0.05). DLCO was lower in ACO than in asthma (68.1 vs 84.1%) and similar to COPD (64.5%). Mean blood eosinophil count was similar in ACO and asthma (360 vs 305 cells/μl) and higher than in COPD (170 cells/μl). Periostin levels were similar in ACO to COPD (36.6 and 36.5 IU/ml) and lower than in asthma (41.5 IU/ml, p < 0.05), whereas FeNO levels in ACO were intermediate.Conclusion
This algorithm classifies as ACO all smoking asthmatics with non-fully reversible airway obstruction and a considerable proportion of e-COPD patients, highlighting those who can benefit from inhaled corticosteroids. 相似文献4.
Ana Madueño Jonathan González-García María del Mar Alonso Socas María Antonia Miguel Gómez María Lecuona 《Enfermedades infecciosas y microbiología clínica》2018,36(8):498-501
Introduction
Limited therapeutic options and high mortality make the management of OXA-48-like carbapenemase-producing Klebsiella pneumoniae (KPOXA-48) bacteraemia complicated. The aim of the study was to describe the clinical characteristics of KPOXA-48 bacteraemia between October 2013 and December 2016.Material and methods
The variables to analyse were retrospectively collected from medical records. Carbapenemase production was confirmed by phenotypic and molecular methods.Results
A total of 38 patients with bacteraemia were included, mainly classified as hospital-acquired (n = 31). The majority of cases were secondary bacteraemia (n = 26), most commonly arising from the urinary tract (n = 11). All isolates presented a multidrug-resistant profile with the extended spectrum beta-lactamase CTX-M-15 and the carbapenemase OXA-48-like production. The crude mortality rate with adequate targeted antibiotic therapy was 0%, rising to 55% with inadequate treatment (p = 0.0015).Conclusions
This study highlights the importance of identifying this resistance mechanism, the patient factors, type of bacteraemia and adequacy of antibiotic therapy in the outcome of bacteraemia. 相似文献5.
Pedro J. Marcos Irene Nieto-Codesido Santiago de Jorge Dominguez-Pazos Arturo Huerta Eduardo Márquez Alejandro Maiso Rodrigo Verdeal Isabel Otero-González Marina Blanco-Aparicio Carmen Montero-Martínez 《Archivos de bronconeumología》2017,53(11):611-615
Introduction
It is not known whether clinical practice guidelines for the treatment of COPD exacerbations with short coursesofsystemic corticosteroids(SC-SCS) are followed in clinical practice.Method
Prospective, observational cohort study in patients admitted due to severe COPD exacerbation. The primary endpoint was the percentage of patients who received SC-SCS as treatment for severe exacerbation (doses of 200-300 mg for 5-6 days). Secondary variables were percentageof patients with duration or reduced dose, dose in the first 24 hours, days of intravenous systemic corticosteroids (SCS), and duration of hospital length of stay (LOS). Simple linear regression was performed with LOS as a dependent variable and multivariate analysis with factors associated with LOS.Results
158 patients were evaluated. 4.4% (7) patients received SC-SCS, 8.7% received a reduced dose and duration was reduced in 15.8%. The median dose and duration of SCS were 602.5 mg (200-1625) and 14 (4-36) days, respectively. We observed an association between days of SCSand LOS (P < .001) and doses of intrahospitalSCSand LOS (P < .001). Factors associated with LOS were doses of intrahospitalSCS received (.01 [95% CI:.007-.013]; P < 0.001), days of steroid treatment (.14 [95% CI .03-.25], P = .009) and PAFI (pO2/FiO2 ratio) at admission (-.012 [95% CI: -.012 to -.002], P = .015).Conclusions
The SCS schedules used in routine clinical practice are longer and administered at a higher dose than recommended, leading toa longer hospital stay. 相似文献6.
J. Antonio García-Bello Joel Ortiz-Flores Francisco E. Torres de la Riva G. Karina Mendoza-Moreno Circe Gómez-Tenorio 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(4):414-419
Introduction
Left ventricular diastolic dysfunction (LVDD) is an independent predictor of mortality in Chronic Kidney Disease (CKD). The increase in the E/e’ ratio is an indicator of LVDD. The association between cardiovascular risk factors (CVRFs) and E/e’ in children with automated peritoneal dialysis (APD) has not been widely studied.Objective
To measure the association between CVRFs and E/e’ in children with CKD on APD.Methods
Cross-sectional, prolective, observational, analytical study of children aged 6–16 years on APD. We recorded age, gender, time since onset, time on dialysis, and measured weight, height, blood pressure, hemoglobin, albumin, calcium, phosphorus, parathyroid hormone, and C-reactive protein. E/e’ ratio was measured and considered to have increased when it was higher than 15.Results
Twenty-nine children were studied, (19 females). Age was 14.0 ± 2.5 years, and 16.9 ± 11.2 months with substitutive therapy. One patient had reduced left ventricular ejection fraction, and 21 (72.4%) had increased E/e’. E/e’ correlated significantly with hemoglobin (r = –0.53, P = .003). Hemoglobin and albumin were significantly lower (9.72 ± 1.9 vs. 12.2 ± 1.8; P = .004 and 3.6 ± 0.5 vs. 4.0 ± 0.3; P = .035) and the proportion of patients with anemia and hypoalbuminemia was significantly higher (85.7% vs. 37.5%; P = .019 and 61.9% vs. 12.5%; P = .035) in patients with increased E/e’. Hemoglobin was the only independent predictor of E/e’ (β = –0.66; P = .020) and patients with anemia were 10 times more likely to have increased E/e’ (95% CI 1.5-65.6, P = .016).Conclusions
75% of the children had increased E/e’. Anemia and hypoalbuminemia were significantly related with an increased E/e’. 相似文献7.
Manuel Gorostidi Mercedes Sánchez-Martínez Luis M. Ruilope Auxiliadora Graciani Juan J. de la Cruz Rafael Santamaría María D. del Pino Pilar Guallar-Castillón Fernando de Álvaro Fernando Rodríguez-Artalejo José R. Banegas 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(6):606-615
Background
Chronic kidney disease (CKD) is a public health problem worldwide. We aimed to estimate the CKD prevalence in Spain and to examine the impact of the accumulation of cardiovascular risk factors (CVRF).Material and methods
We performed a nationwide, population-based survey evaluating 11,505 individuals representative of the Spanish adult population. Information was collected through standardised questionnaires, physical examination, and analysis of blood and urine samples in a central laboratory. CKD was graded according to current KDIGO definitions. The relationship between CKD and 10 CVRF was assessed (age, hypertension, general obesity, abdominal obesity, smoking, high LDL-cholesterol, low HDL-cholesterol, hypertriglyceridaemia, diabetes and sedentary lifestyle).Results
Prevalence of CKD was 15.1% (95% CI: 14.3-16.0%). CKD was more common in men (23.1% vs 7.3% in women), increased with age (4.8% in 18-44 age group, 17.4% in 45-64 age group, and 37.3% in ≥ 65), and was more common in those with than those without cardiovascular disease (39.8% vs 14.6%); all P < .001. CKD affected 4.5% of subjects with 0-1 CVRF, and then progressively increased from 10.4% to 52.3% in subjects with 2 to 8-10 CVRF (P trend < .001).Conclusions
CKD affects one in seven adults in Spain. The prevalence is higher than previously reported and similar to that in the United States. CKD was particularly prevalent in men, older people and people with cardiovascular disease. Prevalence of CKD increased considerably with the accumulation of CVRF, suggesting that CKD could be considered as a cardiovascular condition. 相似文献8.
Almudena Pérez-Torres M. Elena González Garcia Belén San José-Valiente M. Auxiliadora Bajo Rubio Olga Celadilla Diez Ana M. López-Sobaler Rafael Selgas 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(2):141-151
Introduction
Protein-energy wasting (PEW) is associated with increased mortality and differs depending on the chronic kidney disease (CKD) stage and the dialysis technique. The prevalence in non-dialysis patients is understudied and ranges from 0 to 40.8%.Objective
To evaluate the nutritional status of a group of Spanish advanced CKD patients by PEW criteria and subjective global assessment (SGA).Patients and methods
Cross-sectional study of 186 patients (101 men) with a mean age of 66.1 ± 16 years. The nutritional assessment consisted of: SGA, PEW criteria, 3-day dietary records, anthropometric parameters and bioelectrical impedance vector analysis.Results
The prevalence of PEW was 30.1%, with significant differences between men and women (22.8 vs. 33.8%, p < 0.005), while 27.9% of SGA values were within the range of malnutrition. No differences were found between the 2 methods. Men had higher proteinuria, percentage of muscle mass and nutrient intake. Women had higher levels of total cholesterol, HDL and a higher body fat percentage. The characteristics of patients with PEW were low albumin levels and a low total lymphocyte count, high proteinuria, low fat and muscle mass and a high Na/K ratio.The multivariate analysis found PEW to be associated with: proteinuria (OR: 1.257; 95% CI: 1.084–1.457, p = 0.002), percentage of fat intake (OR: 0.903; 95% CI: 0.893–0.983, p = 0.008), total lymphocyte count (OR: 0.999; 95% CI: 0.998–0.999, p = 0.001) and cell mass index (OR: 0.995; 95% CI: 0.992–0.998).Conclusion
Malnutrition was identified in Spanish advanced CKD patients measured by different tools. We consider it appropriate to adapt new diagnostic elements to PEW criteria. 相似文献9.
10.
Pedro Méndez-Chacón Nicolás Riccobelli María P. Dionisi Emilio Sánchez-Álvarez Fernando Bardales-Viguria Carla Méndez-Chacón Rodríguez Jorge B. Cannata-Andía José L. Fernández-Martín 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(3):279-285
Background
Mineral and bone metabolism disorders are common complications in haemodialysis patients that present significant geographical variability.Objectives
The objective of this study was to assess these disorders for the first time in haemodialysis patients from Peru.Methods
The study included 1551 haemodialysis patients from 55 centres affiliated with the Social Health System of Peru in the city of Lima. Demographic data, comorbidities, treatments and biochemical parameters were collected from each patient. Serum calcium, phosphorus and PTH levels were categorised according to the recommended ranges in the KDOQI and KDIGO guidelines.Results
The mean age of the patients was 59.5 ± 15.6 years, with a mean time on haemodialysis of 58.0 ± 54.2 months. All patients were dialysed with a calcium concentration in the dialysis fluid of 3.5 mEq/l and 68.9% of patients were prescribed phosphate-binding agents (98.4% of them calcium carbonate). A high percentage of patients showed serum calcium above, and serum phosphorus below, the recommended ranges in the KDOQI guidelines (32.8% and 37.3%, respectively). More than half of the patients had serum PTH values below the recommended ranges of both the KDOQI and KDIGO guidelines (56.4% and 51.6%, respectively).Conclusions
Patients included in this study were younger than those from other studies and showed both hypophosphataemia and suppressed PTH, probably due to an excessive calcium overload through dialysis fluid and the use of calcium-containing phosphate binding agents. 相似文献11.
Andrea Gómez de la Torre-del Carpio Alejandra Bocanegra-Jesús Katia Guinetti-Ortiz Percy Mayta-Tristán Renzo Valdivia-Vega 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(4):425-432
Objectives
To estimate early mortality in patients with chronic kidney disease who started emergency haemodialysis between 2012 and 2014 in a national referral hospital in Lima, Peru, and to identify risk factors.Design, characteristics, participants and measurements
A retrospective cohort study was conducted by reviewing the medical records of all patients admitted to the hospital's Haemodialysis Unit from 2012 to 2014. Early mortality, defined as death within the first 90 days of starting haemodialysis, as well as age, gender, chronic kidney disease aetiology, comorbidities, cause of death, estimated glomerular filtration rate, vascular access and other variables were evaluated in patients who initiated emergency haemodialysis. Early mortality was estimated using frequencies and risk factors were determined by Poisson regression with robust variance.Results
43.4% of patients were female, 51.5% were aged ≥ 65 years and the early mortality rate was 9.3%. The main risk factors were estimated glomerular filtration rate > 10 ml/min/1.73 m2 (RR: 2.72 [95% CI: 1.60-4.61]); age ≥ 65 years (RR: 2.51 [95% CI: 1.41-4.48]); central venous catheter infection, RR: 2.25 (95% CI: 1.08-4.67); female gender, RR: 2.15 (95% CI: 1.29-3.58); and albumin < 3.5 g/dl (RR: 1.97 [95% CI: 1.01-3.82]).Conclusions
Early mortality was 9.3%. The main risk factor was starting haemodialysis with an estimated glomerular filtration rate > 10 ml/min/1.73 m2. 相似文献12.
Adrian Gerald McNicholl Julio Ducons Jesús Barrio Luis Bujanda Montserrat Forné-Bardera Reyes Aparcero Julio Ponce Robin Rivera José María Dedeu-Cuso Pilar Garcia-Iglesias Miguel Montoro Alicia Bejerano Yolanda Ber-Nieto Belen Madrigal Eva Zapata Carmen Loras-Alastruey Manuel Castro Andrea Nevarez Javier P. Gisbert 《Gastroenterologia y hepatologia》2017,40(10):651-657
Background
Rapid Urease Test (RUT) is a simple, cheap and relatively fast method for diagnosing Helicobacter pylori infection. It is therefore the preferred method used for patients undergoing gastroscopy. Most kits require 24 h to give results. The new Ultra-Rapid Urease Test (URUT) kit by Biohit® requires less than 1 h.Objective
To determine URUT's diagnostic accuracy.Method
Prospective, blind, multi-centre study involving dyspeptic patients. One corpus biopsy and three antral biopsies were obtained during gastroscopy for standard histological analysis, RUT and URUT. The URUT result was checked after 1 min, 5 min, 30 min and 60 min and the RUT was checked over the course of 24 h. Histology was used as the gold standard test.Results
144 patients were included, 68% female, with a mean age of 49 years old; 50% were H. pylori positive. RUT and URUT diagnoses were correct in 85.9% and 90% of the cases, respectively. The mean waiting time for a positive RUT result was 6 h. The sensitivity, specificity, and positive and negative predictive values for RUT were, respectively, 82%, 90%, 89% and 84%. The URUT's results were similar (85%, 94%, 94% and 87%). These figures improved when patients taking PPIs were excluded (RUT: 86%, 91%, 93% and 83%; URUT: 91%, 94%, 96% and 89%). No statistically significant differences were found when comparing RUT and URUT distributions of correct diagnoses (McNemar's Test, p = 0.3) but there was a tendency towards better results with the URUT.Conclusion
The URUT is equivalent to (or slightly better than) the traditional RUT in diagnosing H. pylori infection, and provides results in less than an hour. 相似文献13.
Jesús K. Yamamoto-Furusho Andrea Sarmiento-Aguilar Mario García-Alanis Luis Enrique Gómez-García Joel Toledo-Mauriño Laura Olivares-Guzmán Ana Fresán-Orellana 《Gastroenterologia y hepatologia》2018,41(8):477-482
Introduction
The Hospital Anxiety and Depression Scale (HADS) is a self-administered instrument for outpatients, but its behaviour differs according to the clinical population to which it is applied. In Mexico it is not validated in patients with Inflammatory Bowel Disease (IBD).Objectives
To validate the HADS scale in the Mexican population with IBD.Methods
112 patients with IBD from the “Salvador Zubirán” National Institute of Medical Sciences and Nutrition were included, to whom the HADS was applied and some demographic and clinical characteristics of the disease were evaluated. An exploratory factor analysis was performed and factorial congruence was calculated to determine the construct validity of the HADS, while reliability was evaluated using Cronbach's alpha.Results
The result of the varimax rotation of the 14 items of the HADS explained 50.1% of the variance, having two main factors. Ten items showed high factor loading for the dimensions originally proposed. The internal consistency of the HADS was high (alpha = 0.88) with high values for the congruence coefficients.Conclusions
The HADS scale is a valid instrument to detect possible cases of Anxiety and Depression in Mexican patients with IBD. The validation of this instrument allows its routine use for the integral evaluation of the patient and their timely referral to mental health. 相似文献14.
Juan Antonio Riesco Miranda Bernardino Alcázar Inmaculada Alfageme Ciro Casanova Bartolomé Celli Juan P. de-Torres Carlos A. Jiménez Ruiz 《Archivos de bronconeumología》2017,53(10):574-582
Objective
To describe the evidence- and experience-based expert consensus on the use of single-agent bronchodilators in patients with stable mild-moderate chronic obstructive pulmonary disease (COPD).Methods
Using Delphi methodology, a panel of 7 respiratory medicine experts was established, who, in the first nominal group meeting defined the scope, users, and document sections. The panel drew up 14 questions on the use of single-agent bronchodilators in patients with mild-moderate stable COPD to be answered with a systematic review of the literature. The results of the review were discussed in a second nominal group meeting and 17 statements were generated. Agreement/disagreement with the statements was tested among16 different experts including respiratory medicine experts and primary care physicians. Statements were scored from 1 (total disagreement) to 10 (total agreement). Agreement was considered if at least 70% voted ≥ 7. The level of evidence and grade of recommendation of the systematic literature review was assessed using the Oxford Centre for Evidence-based Medicine levels.Results
A total of 12 of the 17 statements were selected. Specific statements were generated on different profiles of patients with stable mild-moderate COPD in whom single-agent bronchodilators could be prescribed.Conclusions
These statements on the use of single-agent bronchodilators might improve the outcomes and prognosis of patients with stable mild-moderate COPD. 相似文献15.
Carmen Sánchez Perales Teresa Vázquez Sánchez Daniel Salas Bravo Sonia Ortega Anguiano Eduardo Vázquez Ruiz de Castroviejo 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(3):286-296
Atrial fibrillation (AF) represents an important social and healthcare problem. There is wide variability in the prevalence of this arrhythmia in studies analysing patients on haemodialysis (HD).
Objective
To investigate the prevalence, clinical profile and therapeutic management of patients with AF on HD in Andalusia.Methods
We asked the public healthcare system of Andalusia to provide us with the number of patients who were being treated with HD. We asked attending nephrologists from all hospital and outpatient centres in 5 of the 8 Andalusian provinces to perform an electrocardiogram and to fill out a questionnaire on patients selected by simple random sampling.Results
A total of 2,348 patients were being treated with HD in the 5 provinces included in the study. The estimated sample size was 285 patients. We obtained an electrocardiogram and information from 252 patients (88.4%); mean age 65.3 ± 16 years; 40.9% women. Sixty-three patients (25%) had AF. Of these, 36 (14.3%) had AF in the recorded ECG and in the rest it had been documented previously. In the multivariate analysis, older age (OR: 1.071; 95% CI: 1.036-1.107; P = 0.000) and greater time on HD (OR: 1.009; 95% CI: 1.004-1.014; P = 0.000) were independently associated with the presence of AF. Of the patients with AF, 41.3% were on anticoagulant treatment at the time of the study; and 41.2% were on antiplatelet agents.Conclusions
AF in dialysis units is an important finding. Establishing the risk-benefit ratio of anticoagulant treatment constitutes a real challenge. Well-designed clinical trials are pivotal in order to define the rational use of antithrombotic drugs. 相似文献16.
Carlos Antonio Amado Diago Luis Puente Maestu Beatriz Abascal Bolado Juan Agüero Calvo Mercedes Hernando Hernando Irene Puente Bats Ramón Agüero Balbín 《Archivos de bronconeumología》2018,54(2):74-78
Introduction
Dyspnea is a multidimensional symptom, but this multidimensionality is not considered in most dyspnea questionnaires. The Dyspnea-12 takes a multidimensional approach to the assessment of dyspnea, specifically the sensory and the affective response. The objective of this study was to translate into Spanish and validate the Dyspnea-12 questionnaire.Methods
The original English version of the Dyspnea-12 questionnaire was translated into Spanish and backtranslated to analyze its equivalence. Comprehension of the text was verified by analyzing the responses of 10 patients. Reliability and validation of the questionnaire were studied in an independent group of COPD patients attending the pulmonology clinics of Hospital Universitario Marqués de Valdecilla, diagnosed and categorized according to GOLD guidelines.Results
The mean age of the group (n = 51) was 65 years and mean FEV1 was 50%. All patients understood all questions of the translated version of Dyspnea-12. Internal consistency of the questionnaire was α=0.937 and intraclass correlation coefficient was = .969; P < .001. Statistically significant correlations were found with HADS (anxiety r = .608 and depression r = .615), mMRC dyspnea (r = .592), 6 MWT (r = –0.445), FEV1 (r = –0.312), all dimensions of CRQ-SAS (dyspnea r = –0.626; fatigue r = –0.718; emotional function r = –0.663; mastery r = –0.740), CAT (r = 0.669), and baseline dyspnea index (r = –0.615). Dyspnea-12 scores were 10.32 points higher in symptomatic GOLD groups (B and D) (P < .001).Conclusion
The Spanish version of Dyspnea-12 is a valid and reliable instrument to study the multidimensional nature of dyspnea. 相似文献17.
María Isabel Pacheco-Tenza José Antonio Ruiz-Maciá María Navarro-Cots Joan Gregori-Colomé José María Cepeda-Rodrigo Jara Llenas-García 《Enfermedades infecciosas y microbiología clínica》2018,36(1):24-28
Introduction
Strongyloides stercoralis infection is more prevalent in tropical regions but autochthonous cases have been reported in Spain, mainly in La Safor (Valencia). The objective is to describe the strongyloidiasis cases registered in a regional hospital of Alicante province (Spain) and to determine if they were autochthonous cases.Methods
Retrospective study of all diagnosed cases of strongyloidiasis in Vega Baja Hospital (Orihuela, Alicante) between January 1999 and March 2016.Results
A total of 10 cases were found, four of which were autochthonous cases. Two of them presented with a hyper-infection syndrome, with a fatal outcome. All autochthonous cases were in patients ≥ 69 years old with gastrointestinal, cutaneous, and/or respiratory symptoms. Serology was positive in the 8 cases studied. Larvae were found in histopathological samples of the gastrointestinal tract of three patients.Conclusions
We communicate the first autochthonous cases of strongyloidiasis in the region of Vega Baja. Screening programs should be implemented, especially in immunosuppressed patients or patients under chronic corticosteroid treatment. 相似文献18.
Mercedes Ramas Maria G. Donday Adrian G. McNicholl Javier P. Gisbert 《Gastroenterologia y hepatologia》2017,40(10):658-662
Background
A progressive decrease in Helicobacter pylori eradication rates has been described over the years, driving the need for new antibiotic treatments.Aim
To evaluate the efficacy and safety of the addition of rifaximin (Spiraxin®) to standard triple therapy (omeprazole, amoxicillin and clarithromycin) for the eradication of H. pylori.Methods
Independent prospective clinical trial (EUDRACT no.: 2013-001080-23). Forty consecutive adult patients were included with H. pylori infection, dyspeptic symptoms and naive to eradication treatment. A full blood test was performed in the first five patients enrolled to evaluate the safety of the treatment. H. pylori eradication was confirmed with the 13C-urea breath test at least four weeks after the end of treatment with rifaximin 400 mg/8 h, clarithromycin 500 mg/12 h, amoxicillin 1 g/12 h and omeprazole 20 mg/12 h for 10 days.Results
Forty patients were consecutively enrolled, 53% woman, mean age 44 years. Indication for eradication: 60% non-investigated dyspepsia, 38% functional dyspepsia and 2% gastric ulcer. Four patients did not attend the eradication confirmatory breath test. The eradication rate was 61% (95% CI: 45–77%) for the protocol and 55% (40–70%) for intention-to-treat. About 76% of the patients experienced adverse events (35% diarrhea, 14% nausea and 24% metallic taste), none of which was serious. The blood tests did not show significant alterations.Conclusion
Acceptable H. pylori eradication rates are not achieved with rifaximin associated with standard triple therapy for 10 days. 相似文献19.
Almudena Amor-Salamanca Gonzalo Guzzo-Merello Esther González-López Fernando Domínguez Alejandra Restrepo-Córdoba Marta Cobo-Marcos Manuel Gómez-Bueno Javier Segovia-Cubero Luis Alonso-Pulpón Pablo García-Pavía 《Revista espa?ola de cardiología》2018,71(8):612-619
Introduction and objectives
Recovery of left ventricular ejection fraction (LVEF) has been described in alcoholic cardiomyopathy (ACM) after a period of alcohol withdrawal. Nevertheless, the prognostic impact of LVEF recovery in ACM and its determinants have not been studied. We sought to define the role of LVEF improvement in the long-term outcome of ACM and to identify predictors of LVEF recovery in these patients.Methods
We evaluated 101 ACM patients during a median follow-up period of 82 months [interquartile range 36–134].Results
At latest follow-up, 42 patients (42%) showed substantial LVEF recovery defined as an absolute increase in LVEF ≥ 10% to a final value of ≥ 40%. Patients who recovered LVEF had better outcomes than patients who did not (heart transplant or cardiovascular death 1% vs 30%; P < .001). A QRS with < 120 ms (OR, 6.68; 95%CI, 2.30-19.41), beta-blocker therapy (OR, 3.01; 95%CI, 1.09-8.28), and the absence of diuretics (OR, 3.35; 95%CI, 1.08-10.42) predicted LVEF recovery in multivariate analysis. Although alcohol cessation did not predict LVEF recovery, none of the patients (n = 6) who persisted with heavy alcohol consumption recovered LVEF. The rate of patients who recovered LVEF did not differ between abstainers and moderate drinkers (44% vs 45%; P = .9).Conclusions
The LVEF recovery is associated with an excellent prognosis in ACM. Beta-blocker treatment, QRS < 120 ms and absence of diuretics are independent predictors of LVEF recovery. LVEF recovery is similar in moderate drinkers and abstainers.Full English text available from: www.revespcardiol.org/en 相似文献20.
María Fernández-Prada María Rodríguez-Martínez Rebeca García-García María Dolores García-Corte Carmen Martínez-Ortega 《Enfermedades infecciosas y microbiología clínica》2018,36(2):78-83